1. Positively Connected for Health (PC4H)
The Children’s Hospital of Philadelphia, Philadelphia, PA
Nadia Dowshen, MD; Susan Lee, MPH; Siobhan Gruschow, MPH, MEd
Philadelphia FIGHT, Philadelphia, PA
Helen Koenig, MD, MPH; Ally Richman, PhD; Graham Beckley

2. PC4H Overview iknowUshould2
Positively Connected for Health (PC4H) will work with HIV+ and at-risk youth in Philadelphia through three distinct social media interventions:
APPlify Your Health
A digital health literacy workshop that uses pop-up iPad and smartphone labs to support youth who will be engaged in our two social media interventions
iknowUshould2
An existing CHOP web-based social media campaign that encourages HIV testing and linkage to care for status unknown youth
TreatYourSelf
A mobile app designed for and with input from HIV+ youth to improve adherence to antiretroviral therapy and engagement in care

3. Implementation Enrollment: May 2017 Regulatory Process Update
1 Enrolled to date
CHOP: 4 consented participants
FIGHT: 6 consented participants
Monthly enrollment targets: 6-8 youth/site
Regulatory Process Update
Expanded eligibility criteria
Removed Drexel as backend app data manager
-Amendment 5 IRB approval (May 2017)
- Amendment 5 is under IRB review (Expected approval June 2017 )
-Need to submit Amendment re hosting (Expected IRB approval TBD)

4. Implementation Technology Development
TYS Android version of the app in final stages of development
Drexel will no longer host backend data; CHOP will host
CHOP & Drexel modifying backend for deployment
Hold on iOS version
Data Transfers Agreements (CHOP’s Office of Tech Transfer)
Business Association Agreement (BAA) with Drexel not needed
Data Transfer Agreement (DTA) between CHOP and UCLA ETAC is complete; FIGHT still needs to complete a DTA
Regulatory
Received Blanket Certificate of Confidentiality (CoC) on March 6th

5. Implementation Challenges & Successes
Privacy concerns with management of backend data
Delays in app development due to limited resources and experience of development team
No longer able to develop iOS version of app due to time constraints and complexity of iOS app store
Steps for Overcoming Challenges
Meetings with leadership at CHOP, FIGHT, and Drexel
CHOP Department of Biomedical Informatics (DBHi) will host backend
Drexel’s College of Computing and Informatics has made additional investments, including support from more senior developers to work on app and hosting
Purchasing Android phones and plans for iOS participants
Successes
Developers created minimum viable product for Android app
Backend data view and maintenance streamlined for research team

6. Recruitment: Target Population/Settings
Target Population Across Sites:
125 HIV-positive youth age who are virally
unsuppressed and/or have been out of for at least 6 months
in the last 2 years
Philadelphia FIGHT
(195 HIV+ youth between years old)
Y-HEP Health Center
Jonathan Lax Health Center
John Bell Health Center
Children’s Hospital of Philadelphia
(225 HIV+ youth between years old)
Adolescent Initiative
Special Immunology
Philadelphia
Philadelphia FIGHT’s AIDS Education Month (AEM) Events: CHOP had a table at the HIV Prevention and Outreach Summit with study materials
iknowUshould2 campaign will link any newly diagnosed youth to care with possibility of enrollment into PC4H
Connect to Protect (C2P) partner sites
FIGHT and CHOP’s counseling, testing, referral, and navigation team will link newly diagnosed youth each year to PC4H

7. PC4H Flyer
CHOP
FIGHT
Created with input from IRB, clinical providers, researchers, and CHOP’s Youth Community Advisory Board (YCAB)

8. Participant Recruitment
Potential Participants (N=22)
Approached (n=15)
Consented & Screened (n=4)
Needed more time (n=6)
Not good fit (n=5)
Not interested (n=7)
Potential Participants (n=35)
Recruited (n=17)
Couldn’t meet, but interested
(n=5)
Not Interested
(n=1)
Consented (n=6)
Enrolled (n=1)
No show (n=5)
Missed (n=18)
As of June 12, 2017

9. Outreach and Recruitment Methods
CHOP HIV multidisciplinary care team weekly case review referrals
Manual medical chart review of CHOP medical records by physician
Word of mouth solicitation
Flyers in CHOP exam and consult rooms and C2P partner sites
Distribution of flyers and ICF forms to potential participants at clinic visits
Philadelphia FIGHT faculty/staff weekly forum provider referrals
EMR medical chart review of scheduled patients
Flagged charts so providers know to ask potential participants if they are interested
Flyers in FIGHT waiting areas
Staff at Health centers, case managers, treatment education staff, CTRN staff
Word of mouth solicitation
Philadelphia FIGHT
Provider referral: All currently-enrolling studies will be discussed in a weekly forum where all Philadelphia FIGHT staff who are capable of referring patients will be present
Chart review: Research coordinators will review charts of scheduled patients as often as possible. Every attempt will be made to perform daily chart reviews. Post-it notes  will be used to mark the charts of potential research candidates and to help remind clinicians that a particular patient may be eligible for a particular study
Database query: Queries will be conducted on all available and useful databases when deemed appropriate
Flyers in waiting rooms, clinics, education sites
The Children’s Hospital of Philadelphia
Provider referral
Weekly case review-The Children’s Hospital of Philadelphia Adolescent Initiative (CHOP AI) holds a weekly case review on Tuesday mornings with all AI physicians, nurse practitioners, social workers, and research staff and will be able to discuss the past week’s patients and the upcoming week’s scheduled patients to identify potential participants for study recruitment.
Flyers
Word of mouth solicitation

10. Recruitment Successes & Challenges
Adolescent Initiative and Special Immunology clinical teams identifying & referring clinic patients
Reviewing and flagging potential patient charts
Research team collaborates with Social Workers to get notified of possible participants
Challenges
FIGHT medical providers want different communication for recruitment (e.g., each day, list of total provider patients)
Approaching walk-ins at FIGHT
Steps for Overcoming Challenges
FIGHT recruiter meeting individually with medical providers to develop individualized recruitment strategies
Messaging with Front Desk Staff to approach walk-ins: will have access to clinical chat accounts
SW notes not always in EPIC schedule for research view

11. Additional App Updates
Minimum Viable Product
Simplified avatar
Backend data temporarily stored locally
Updates to participants
Avatar will be silhouette  stock images created by research team  customizable
Backend data will be stored locally on participant phones until CHOP backend set up is complete
Current version of the app to final version of the home page

12. Contact Information
Philadelphia FIGHT
Helen Koenig, MD, MPH
Ally Richman, PhD
Graham Beckley
The Children’s Hospital of Philadelphia
Nadia Dowshen, MD
Susan Lee, MPH
Siobhan Gruschow, MPH, MEd
Discussion